Harnessing mHealth to Support Loved Ones of Individuals in Recovery from Substance Use Disorders

About This Grant

Substance use disorders (SUDs) are one of the most prevalent chronic behavioral health issues in the United States and are responsible for significant morbidity and mortality. However, there is a high rate of recovery from SUDs. The loved ones of those in recovery can be an important source of support. Unfortunately, relationships are often strained by the chronic relapsing and remitting nature of SUDs, and SUD-related stigma may impede support from loved ones. Efforts to implement evidence-based interventions for loved ones have been hampered by a number of factors, including required specialized training for interventionists and the lengthy nature of the interventions. Efficacious and scalable interventions are therefore needed to guide the loved ones of those in recovery in evidence-based approaches to support the recovery process. mHealth facilitated interventions could be used to address these barriers, allowing for more efficient use of interventionist time through automation while maintaining “on demand” availability and the human touch that many find helpful. We propose to refine the recovery specific content of the KulaMind Platform (KM-R), which is an AI-powered online program that aims to improve healthy family/social network behaviors and self- regulation skills of loved ones of those in recovery to strengthen the social support network. In addition to online skill building and educational modules, each loved one is matched with a coach who provides emotional support, accountability, and troubleshooting via one-on-one video sessions and “on demand” text-based support. Lastly, KM-R includes access to a community forum that allows loved ones to connect with others with shared experience. In the R61 phase, we will work with our Community Advisory Board to refine the content of KM-R; conduct an open label pilot study with 30 dyads (individual in early recovery and a loved one), in which the loved ones receive access to KM-R for 3 months, to examine the feasibility, acceptability, and preliminary signs of efficacy of the intervention; and further refine KM-R based on participant experiences. In the R33 phase, we will randomly assign 460 dyads consisting of an individual in recovery and a nominated loved one to the KM-R condition (3 months of access to KM-R for the loved one) vs. loved one referral to Nar-Anon. We will follow the dyads for 6 months. It is hypothesized that KM-R, relative to Nar-Anon referral, will result in higher recovery capital among individuals in recovery and less SUD-related stigma among loved ones (primary outcomes). In addition, in dyads assigned to KM-R vs. Nar-Anon referral, we expect better relationship satisfaction; less substance use among the individuals in recovery; and enhanced knowledge about SUDs and evidence-based treatment and greater self-efficacy to support recovery among loved ones (secondary outcomes). From study outset, we will solicit Community Advisory Board, participant, and stakeholder input regarding potential implementation challenges. This will allow us to proactively address these challenges and will enhance future clinical integration should KM-R be found efficacious.